Pharmacy Claims Representative 2 – Patient Financial Services

Humana

. Adjudicate and process pharmacy claims for payment .

Posted 10/14/2026full-timeRemote • United StatesJunior💰 $40,000 - $52,300 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in pharmacy claims adjudication and customer service, with a strong ability to analyze data and provide financial support while ensuring compliance with HIPAA regulations.

Highest-signal resume keywords

Pharmacy Claims AdjudicationCustomer Service ExperienceMicrosoft WordMicrosoft ExcelMicrosoft Outlook

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Pharmacy Claims ProcessingData AnalysisFinancial SupportCase DocumentationPatient Assistance Programs

Soft Skills

Relationship DevelopmentInternal Customer SupportCommunication Skills

Tools & Technologies

Windows Based Systems

Industry Keywords

HIPAA ComplianceInsurance VerificationCo-Pay AnalysisDeductible Analysis

About the role

Key responsibilities & impact

Adjudicate and process pharmacy claims for payment
Analyze and answer inquiries regarding pharmacy claims adjudication, including payment method, co-pay or deductible amounts, and reasons for denial
Analyze data and provide financial support
Develop relationships with foundations and manufacturers on behalf of CenterWell Specialty Pharmacy customers
Provide internal customer support for the entire Pharmacy
Source patient assistance programs and/or foundations to help patients meet out-of-pocket responsibilities
Make inbound and outbound calls regarding patient assistance programs, billing inquiries, and insurance verification
Provide internal and external customer service
Document case files with complete notes
Complete special projects with varied and complex components as needed

Requirements

What you’ll need

1 or more years of customer service experience handling both incoming and outgoing phone calls in a professional setting
Comprehensive knowledge of Microsoft Products including Word, Excel and Outlook
Intermediate to High level of Windows Based system navigation
Must be able to work an 8 hour shift between 8am and 8pm EST Monday-Friday
Overtime may be required during peak season
Minimum internet speed of 25 Mbps download and 10 Mbps upload
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Benefits

Comp & perks

Medical benefits
Dental benefits
Vision benefits
401(k) retirement savings plan
Paid time off
Company holidays
Personal holidays
Paid parental leave
Paid caregiver leave
Short-term disability
Long-term disability
Life insurance
Remote work arrangement
Home internet requirements/support for effective work
Occasional travel to Humana offices for training or meetings may be required